Viral Hepatitis Flashcards
Which viral hepatitis types have an oral faecal route of transmission?
A and E
Which types of viral hepatitis travel via IV?
Hep B and Hep C
Also Hep D in the presence of B
How long does the pre-icteric phase of acute hepatitis last and what signs are there?
1-2 weeks:
Flu-like, Anorexia, Fatigue, Malaise, N+V, Fever, Muscle pain, Headache.
Increased ALT/AST
How long does the icteric phase of acute hepatitis last? and what signs are associated with it?
2-4 weeks:
Jaundice, pale stools, dark urine, abdominal pain, itch, arthralgia and skin rash
Increased ALT/AST
Increased Bilirubin in blood
Which types of viral hepatitis can cause Chronic Hepatitis?
HBV and HCV
Define Chronic Persistent Hepatitis
Benign inflammatory condition of the liver, with limited fibrosis and no necrosis
Name three features of Chronic Persistent Hepatitis
Often asymptomatic
Hepatomegaly
ONLY AST raised, other LFTs normal
What investigations would you do for suspected Chronic Persistent Hepatitis? and what would it show?
Liver biopsy → some fibrosis but no necrosis
If the liver biopsy shows progressive inflammation, with necrosis of hepatocytes → cirrhosis (degeneration of cells, fibrous thickening of liver tissue), what does this suggest?
Chronic Active Hepatitis
What cancer does Chronic Active Hepatitis increase the risk of?
Hepatocellular Carcinoma
What would the liver function tests show for Chronic Active Hepatitis?
Increased AST and ALT
With other LFTs derangement with progression
What are the signs for Hepatic Failure?
Severe impairment of liver function
Jaundice, Coagulopathy, Hypoalbuminaemia, Encephalopathy, Multiorgan failure
What type of hepatitis does HAV cause? And what is its route of transmission?
Faecal Oral
Acute hepatitis
What are diagnostic markers for Hepatitis A?
Anti HAV-IgM - acute infection
Anti HAV-IgG - prior infection
As IgM acts first, and IgG is for long term immunity
How is Hepatitis B transmitted?
Sex or Blood (IV drugs, tattoos/piercings, transfusions)
Also transmitted vertically (childbirth) in developing countries.
What type of hepatitis does Hepatitis B cause? Acute or chronic?
Acute, but can lead to chronic if not cleared (both persistent and active possible)
How are the features of Hep A and Hep B similar?
They both may be sub-clinical, but may have an acute pre-icteric phase (1-2 weeks) followed by a icteric phase (2-4 weeks)
How is Hep B diagnosed?
HBV serology - Antigens → current infection
Antigens: HBsAg - Hep B surface antigen
HBeAg - envelope antigen/HBcAg - core antigen
Antibodies - immunity (vaccination or recent infection)
AntiHB IgG - past infection
AntiHBe - body in control: as antivirals react to HBeAg with AntiHBe
What are the treatment indications for HBV?
Chronic >6 months
Viral load >2000iu/ml
Evidence of on-going liver disease
What is the first line treatment for HBV?
PET: Peginterferon, Entecavir, Tenofovir
Second line: Lamivudine, Adefovir, Telbivudine
What virus is only infective with co-existing hep B? And how does it affect hep B progression?
Hep D
It worsens hep B progression → cirrhosis/hepatocellular carcinoma (chronic active infection)
How is hep C transmitted?
Blood
What is Hep C more likely to cause? Acute hepatitis or chronic hepatitis?
Chronic
How would hep C chronic phase manifestation appear on LFTs?
Deranged ALT/AST raised more than ALP/GGT
